1. VERTIGO (Mild, Moderate, and Severe Vertigo)
Topic Overview
Vertigo is a feeling that you or your surroundings are moving when there is no actual movement. The
motion commonly is described as a feeling of spinning or whirling, but it also can include sensations of
falling or tilting. Vertigo can cause nausea and vomiting. It may be hard to walk or stand, and you may
lose your balance and fall.
Mild vertigo occurs occasionally for a brief time and goes away on its own. Nausea, but not
vomiting, also may be present.
Moderate vertigo requires that you lie down and lie still (no head motion) to stop the feeling of
movement. Nausea is present and you may vomit occasionally, but you are able to keep fluids
down.
Severe vertigo occurs when the feeling of movement is continuous even when lying down.
Nausea and vomiting are so severe that you will vomit most of the fluid you drink.
Vertigo Overview
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Vertigo is the feeling that you or your environment is moving or spinning. It differs from dizziness in that vertigo
describes an illusion of movement. When you feel as if you yourself are moving, it's called subjective vertigo,
and the perception that your surroundings are moving is called objective vertigo.
Unlike nonspecific lightheadedness or dizziness, vertigo has relatively few causes.
Vertigo Causes
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Vertigo can be caused by problems in the brain or theinner ear.
Benign paroxysmal positional vertigo(BPPV) is the most common form of vertigo and is
characterized by the sensation of motion initiated by sudden head movements or moving the
head in a certain direction. This type of vertigo is rarely serious and can be treated.
Vertigo may also be caused by inflammation within the inner ear (labyrinthitis or vestibular
neuritis), which is characterized by the sudden onset of vertigo and may be associated
with hearing loss. The most common cause of labyrinthitis is a viral or bacterial inner ear
infection.
Meniere's disease is composed of a triad of symptoms including episodes of vertigo, ringing in
the ears (tinnitus), and hearing loss. People with this condition have the abrupt onset of severe
vertigo and fluctuating hearing loss as well as periods in which they are symptom-free.
Acoustic neuroma is a type of tumor of the nerve tissue of the ear that can cause vertigo.
Symptoms include vertigo with one-sided ringing in the ear and hearing loss.

2. Vertigo can be caused by decreased blood flow to the base of the brain. Bleeding into the back
of the brain (cerebellarhemorrhage) is characterized by vertigo, headache, difficulty walking,
and inability to look toward the side of the bleed. The result is that the person's eyes gaze away
from the side with the problem. Walking is also extremely impaired.
Vertigo is often the presenting symptom inmultiple sclerosis. The onset is usually abrupt, and
examination of the eyes may reveal the inability of the eyes to move past the midline toward
the nose.
Head trauma and neck injury may also result in vertigo, which usually goes away on its own.
Cervical vertigo can be caused by neck problems such as impingement of blood vessels or nerves
from neck injuries.
Migraine, a severe form of headache, may also cause vertigo. The vertigo is usually followed by
a headache. There is often a prior history of similar episodes but no lasting problems.
Complications from diabetes can cause arteriosclerosis (hardening of the arteries) which can
lead to lowered blood flow to the brain, causing vertigo symptoms.
Picture of the ear and internal ear structures.
Vertigo Symptoms
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Vertigo implies there is a sensation of motion either of the person or the environment, often perceived
as if the room is spinning around you. This should not be confused with symptoms of

3. lightheadednessor fainting. Vertigo differs from motion sickness in that motion sickness is a feeling of
being off-balance and lacking equilibrium, caused by repeated motions such as riding in a car or boat.
If true vertigo exists, symptoms include a sensation of disorientation or motion. In addition, the
individual may also have any or all of these symptoms:
o
nausea or vomiting,
o
sweating, and/or
o
abnormal eye movements.
The duration of symptoms can be from minutes to hours, and symptoms can be constant or
episodic. The onset may be due to a movement or change in position. It is important to tell the
doctor about any recent head trauma or whiplash injury as well as any new medications the
affected individual is taking.
The person may have hearing loss and a ringing sensation in the ears.
The person might have visual disturbances, weakness, difficulty speaking, a decreased level of
consciousness, and difficulty walking.
When to Seek Medical Care
Any signs and symptoms of vertigo should be evaluated by a doctor. The majority of cases of vertigo are
harmless. Although vertigo can be debilitating, most causes are easily treated with prescription
medication. Have a doctor check any new signs and symptoms of vertigo to rule out rare, potentially
serious, or life-threatening causes.
Certain signs and symptoms of vertigo may require evaluation in a hospital's emergency department,
such as:
Double vision
Headache
Weakness
Difficulty speaking
Abnormal eye movements
Altered level of consciousness, not acting appropriately, or difficulty arousing
Difficulty walking, lack of coordination, or weakness of the arms and/or legs
Vertigo Diagnosis
The evaluation of vertigo consists primarily of amedical history and physical exam.
The history is comprised of four basic areas.
1. The doctor may want to know if the patient feels any sensation of motion, which may indicate
that true vertigo exists. Report any nausea, vomiting, sweating, and abnormal eye movements.

4. 2. The doctor may ask how long the patient has symptoms and whether they are constant or come
and go. Do the symptoms occur when moving or changing positions? Is the patient currently
taking any new medications? Has there been any recent head trauma or whiplash injury?
3. Are there any other hearing symptoms? Specifically, report any ringing in the ears or hearing
loss.
4. Does the patient have other neurological symptoms such as weakness, visual disturbances,
altered level of consciousness, difficulty walking, abnormal eye movements, or difficulty
speaking?
The doctor may perform tests such as a CT scan if a brain injury is suspected to be the cause of vertigo.
Blood tests to check blood sugar levels and the use of an electrocardiogram (ECG) to look at heart
rhythm may also be helpful.
N
Vertigo Treatment
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There are a variety of treatments for vertigo including self-care remedies, medications, and physical
therapy maneuvers.
Vertigo Self-Care at Home
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Home therapy should only be undertaken if you have already been diagnosed with vertigo and are
under the supervision of a doctor.
If your doctor approves, there are some natural home remedies that may help relieve the symptoms of
your vertigo.
A modified Epleymaneuver is a type of physical therapy often prescribed that involves head and
body movements done while sitting on a bed. Traditionally, it is performed in a doctor or
physical therapist's office, but it may also be prescribed to do at home. Once a patient has
received proper instruction, this maneuver can resolve symptoms within a week for many
patients.
Vitamin D supplementation may be beneficial for patients diagnosed with benign paroxysmal
positional vertigo. Your doctor can check to see if you have a vitamin D deficiency.
Herbal remedies such as ginger root,ginkgo biloba, and coriander may help reduce vertigo
symptoms in some people.
Acupuncture may be helpful in resolving symptoms of some types of vertigo.
Avoid substances that can affect circulation, including caffeine, tobacco, or alcohol.
Drink plenty of fluids.

5. Vertigo Medical Treatment
The choice of treatment will depend on the diagnosis.
Vertigo can be treated with medicine taken by mouth, through medicine placed on the skin (a
patch), or drugs given through an IV.
Specific types of vertigo may require additional treatment and referral:
o
Bacterial infection of the middle earrequires antibiotics.
o
For Meniere's disease, in addition tosymptomatic treatment, people might be placed on
a low salt diet and may require medication to increase urine output.
o
A hole in the inner ear causing recurrent infection may require referral to an ear, nose,
and throat (ENT) specialist for surgery.
In addition to the drugs used for benign paroxysmal positional vertigo, several physical
maneuvers can be used to treat the condition.
o
Vestibular rehabilitation exercises, also referred to as Epleymaneuvers as mentioned
before, consist of having the patient sit on the edge of a table and lie down to one side
until the vertigo resolves followed by sitting up and lying down on the other side, again
until the vertigo ceases. This is repeated until the vertigo no longer occurs.
o
Particle repositioning maneuver is a treatment based on the idea that the condition is
caused by displacement of tiny stones in the balance center (vestibular system) of the
inner ear. The head is repositioned to move the stones to their normal position. This
maneuver is repeated until the abnormal eye movements are no longer visible.
Vertigo Medications
Commonly prescribed medications for vertigo include the following:
meclizine hydrochloride (Antivert)
diphenhydramine (Benadryl)
scopolamine transdermal patch (Transderm-Scop)
promethazine hydrochloride (Phenergan)
diazepam (Valium)
These medications should be taken only as directed and under the supervision of a doctor.
Vertigo Follow Up
Anyone with a new diagnosis of vertigo should follow-up with his or her doctor or be referred directly to
a neurologist or ENT specialist.
Vertigo Prevention

6. People whose balance is affected by vertigo should take precautions to prevent injuries from
falls.
Those with risk factors for stroke should control their high blood pressure and high
cholesterol and stop smoking.
Individuals with Meniere's disease should limit salt in their diet.
Vertigo Prognosis
The prognosis depends on the source of the vertigo.
Vertigo caused by problems in the inner ear, while usually self-limited, in some cases can
become completely incapacitating. The use of drugs and rehabilitation exercises is the mainstay
of treatment. Most commonly this will cure the symptoms or make the condition tolerable.
The prognosis of vertigo from a brain lesion depends on the amount of damage done to
the central nervous system. Vertigo caused by a brain lesion may need emergency evaluation by
a neurologist and/orneurosurgeon.
Synonyms and Keywords
vertigo, dizzy, dizziness, disequilibrium, lightheaded, benign positional vertigo, Meniere disease, labyrinthitis,
migraine, acoustic neuroma, cerebellar hemorrhage, hearing loss, tinnitus, Epleymaneuver, particle
repositioning maneuver
Authors and Editors
Author: John P. Cunha, DO, FACOEP
Editor: Melissa Conrad Stoppler, MD
REFERENCES:
"Dizziness: Lightheadedness and Vertigo - Home Treatment." WebMD Medical Reference from
Healthwise. 12 Jan. 2011.
"Simple Home Remedy for Vertigo Works." WebMD. 2004.
Buki, B., et al. "Vitamin D deficiency and benign paroxysmal positioning vertigo." Medical Hypotheses.
80.2 (2013): 201-204.
Cesarani, A., et al. "Gingko biloba (EGb 761) in the treatment of equilibrium disorders." Advances in
Therapy. 15.5 (1998): 291-304.
Grontved, A. and E. Hentzer. "Vertigo-reducing effect of ginger root. A controlled clinical study." ORL
Journal for Oto-Rhino-Laryngology. 48.5 (1986): 282-286.
Huang, Q. "Fifty cases of vertebrobasilar ischemic vertigo treated by acupuncture." Journal of Traditional
Chinese Medicine. 29.2 (2009): 87-89.